Provider Demographics
NPI:1942318357
Name:DELSESTO, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:DELSESTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3461 S COUNTY TRL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1465
Mailing Address - Country:US
Mailing Address - Phone:401-471-6510
Mailing Address - Fax:401-471-6530
Practice Address - Street 1:3461 S COUNTY TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1465
Practice Address - Country:US
Practice Address - Phone:401-471-6510
Practice Address - Fax:401-471-6530
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000025569OtherBLUE CROSS
RI405407OtherBLUE CHIP
0407376OtherUNITED HEALTHCARE
RI9020824Medicaid
G97237Medicare UPIN
RI9020824Medicaid